title: Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous coronary intervention: analysis from the HORIZONS-AMI trial.
abstract: BACKGROUND
  Both ST-segment resolution (STR) and myocardial blush grade (MBG) have prognostic utility after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction. We sought to clarify how frequently MBG and STR provide discordant measures of reperfusion success and to determine the independent prognostic significance of each on long-term outcomes.
  
  
  METHODS
  In HORIZONS-AMI, core laboratory measures of both MBG and STR were assessed in 2,367 patients undergoing primary PCI. Four groups were identified based on MBG (grades 2/3 vs 0/1) and STR (≥50% vs <50%). A multivariable model identified predictors of death and major adverse cardiac events at 3 years.
  
  
  RESULTS
  Myocardial blush grade 2/3 was achieved in 77.7% of patients, and STR ≥50% was achieved in 75.1% of patients. Myocardial blush grade and STR were discordant in 765 patients (30.9%). By multivariable analysis, MBG 2/3 compared with 0/1 was an independent predictor of lower mortality at 3 years (4.4% vs 8.4%, adjusted hazard ratio [HR] = 0.57 [0.39, 0.82], P = .003). In contrast, STR ≥50% compared with <50% was not associated with mortality (5.1% vs 5.9%, adjusted HR = 1.11 [0.68, 1.56], P = .89). However, repeated revascularization at 3 years was less frequent when STR ≥50% (12.4% vs 17.6%, adjusted HR = 0.74 [0.58, 0.95], P = .02). In contrast, MBG 2/3 vs 0/1 was not associated with reduced repeated revascularization (13.6% vs 14.1%, adjusted HR = 1.02 [0.79, 1.33], P = .85).
  
  
  CONCLUSIONS
  In HORIZONS-AMI, MBG and STR after primary PCI were concordant in only 70% of patients and provided complementary prognostic information. Myocardial blush grade predicted long-term survival, whereas STR predicted freedom from repeated revascularization.
authors.affiliation: New York Methodist Hospital, Brooklyn, NY; Cardiovascular Research Foundation, New York, NY. Electronic address: sjb9005@nyp.org.
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.forename: Jose M
authors.initials: JM
authors.lastname: Dizon
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Alejandra
authors.initials: A
authors.lastname: Guerchicoff
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Michael
authors.initials: M
authors.lastname: Farkouh
authors.forename: Bruce
authors.initials: B
authors.lastname: Brodie
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Helen
authors.initials: H
authors.lastname: Parise
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D011379:Prognosis; D020127:Recovery of Function; D013997:Time Factors